Medicare Part D coverage · sodium phenylbutyrate · RxCUI 199369
sodium phenylbutyrate 500 MG Oral Tablet
Per the CMS 2026 Part D formulary file, sodium phenylbutyrate 500 MG Oral Tablet is covered by 4,751 Medicare Part D plans (94% of enrollable products), averaging Tier 4.4, with prior authorization required on 79.7% of covering formularies.
- 94%
- Plan coverage
- 4,751
- Plans covering
- T4.4
- Avg tier
- 79.7%
- Prior auth required
What the CMS Formulary Data Shows for sodium phenylbutyrate 500 MG Oral Tablet
Per the CMS 2026 Part D formulary file, sodium phenylbutyrate 500 MG Oral Tablet (RxNorm concept RXCUI 199369, generic name sodium phenylbutyrate) appears on 236 distinct formulary files spanning 4,751 Medicare Part D plan offerings - 94% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.4.
Real-world access to sodium phenylbutyrate 500 MG Oral Tablet depends on utilization management as much as tier placement: 79.7% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 69 Part D beneficiaries filled sodium phenylbutyrate 500 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $3,435,632 and an average per-beneficiary annual cost of $49,791.77. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry sodium phenylbutyrate 500 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 236
- Plans covering
- 4,751
- Coverage rate
- 94%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 79.7% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 69
- Total spending
- $3,435,632
- Avg per beneficiary
- $49,791.77
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering sodium phenylbutyrate 500 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
Show the next 30 plans
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | No | $0 | CA |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | Yes | $4.80 | TX |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | Yes | $5.00 | OK |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | Yes | $8.80 | MI |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | Yes | $15.20 | IL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is sodium phenylbutyrate 500 MG Oral Tablet covered by Medicare Part D?
Yes, sodium phenylbutyrate 500 MG Oral Tablet is covered by 4,751 Medicare Part D plans (94% of all Part D formularies).
What tier is sodium phenylbutyrate 500 MG Oral Tablet on Medicare Part D plans?
sodium phenylbutyrate 500 MG Oral Tablet averages Tier 4.4 across Part D plans, ranging from Tier 1 to Tier 6.
Does sodium phenylbutyrate 500 MG Oral Tablet require prior authorization?
79.7% of Part D formularies require prior authorization for sodium phenylbutyrate 500 MG Oral Tablet. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on sodium phenylbutyrate 500 MG Oral Tablet?
In 2023, total Medicare Part D spending on sodium phenylbutyrate 500 MG Oral Tablet was $3,435,632, covering 69 beneficiaries. The average spend per beneficiary was $49,791.77.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- omadacycline 150 MG Oral Tablet [Nuzyra] T4.4
- 20 ML immunoglobulin G, human 100 MG/ML Injection [Octagam] T4.4
- nilotinib d-tartrate 50 MG Oral Capsule T4.4
- {14 (migalastat 123 MG Oral Capsule [Galafold]) } Pack [Galafold 28 Day Wallet] T4.4
- 20 ML immunoglobulin G, human 50 MG/ML Injection [Octagam] T4.4
- elafibranor 80 MG Oral Tablet [Iqirvo] T4.4
Similar prior-authorization rate
- stiripentol 250 MG Oral Capsule [Diacomit] 79.6% PA
- 1 ML evolocumab 140 MG/ML Auto-Injector [Repatha] 79.9% PA
- 1 ML glatiramer acetate 20 MG/ML Prefilled Syringe [Glatopa] 79.5% PA
- 0.6 ML pegfilgrastim-jmdb 10 MG/ML Prefilled Syringe [Fulphila] 79.9% PA
- 1 ML meperidine hydrochloride 50 MG/ML Injection 80% PA
- 24 HR hydromorphone hydrochloride 32 MG Extended Release Oral Tablet 80% PA